What the WHO report on hypertension says about India: 188.3 million have it, only 37% diagnosed

“High blood pressure kills. In fact, cardiovascular diseases are the world’s leading cause of death. I know the dangers of hypertension from personal experience, because it is a condition I live with. I am fortunate that I was diagnosed, have access to good medical care, and medicines… Unfortunately, the same is not true for the majority of those with hypertension, a disease that is often dubbed the silent killer,” said WHO director general Dr Tedros Adhanom Ghebreyesus in the report.

Experts say that there are challenges at every level when it comes to hypertension — from getting a diagnosis to initiating treatment and controlling it successfully.

What are the red flags highlighted by the report?

The report says that of the 188.3 million estimated to have the condition in India, only 37% get diagnosed. And many do not start their treatment even after diagnosis. Only 30% of the estimated people living with hypertension start treatment, while only 15% manage to keep their blood pressure under control.

While the number of adults living with uncontrolled hypertension is on the decline, the report shows that it’s not fast enough. The report says that by treating half the people with hypertension — which has been termed as the “progressive scenario” — the country can prevent 4.6 million deaths due to heart attacks and strokes. In fact, uncontrolled hypertension is the reason for 52% of the deaths from cardiovascular diseases like heart attacks and strokes in India, the report found. More lives can be saved if the “aspirational scenario” of 75% control can be achieved.

“There is actually a rule of halves when it comes to hypertension. In any population, only half the people with hypertension get diagnosed. Of the people who do get diagnosed, half end up taking the treatment. And of the people who receive treatment, only half manage to control their blood pressure. In some of the developed countries, where the whole population is screened and treatment is free, the proportion might be better than half. And, in some lower middle income countries — and, as this report shows, even India — the outcome is worse than the rule of half,” said Dr V Mohan, chairman of Dr Mohan’s Diabetes Specialities Centre in Chennai.

Why do doctors insist on screening and pills to control hypertension?

One of the most important concerns that doctors have is that high blood pressure, per se, does not have any symptoms. However, uncontrolled hypertension over the years can lead to not only heart attacks and strokes, but it can also irreversibly damage the heart and the kidneys.

Dr Rakesh Yadav, professor of cardiology from the All India Institute of Medical Sciences, New Delhi, said: “Many get diagnosed only when they are admitted to a hospital for some other treatment or when they land up with complications of hypertension. What is of more concern, however, is that even when diagnosed, people are reluctant to take the medicine. People feel that they are absolutely fine. Hypertension is a silent killer. There are no symptoms really until there are complications.”

Dr Mohan said sometimes, people do not even turn up at the screening camps because they think they are absolutely fine.

Dr Yadav suggested that from their 20s and early 30s, people should start getting screened for hypertension once every 10 years. The period should be brought down to every five years when they turn 50.

Why is it important for a person with hypertension to start and continue treatment?

Along with making lifestyle changes such as eating healthy, cutting down salt, not smoking or drinking, increasing physical activity, reducing stress, and improving sleep, once diagnosed, people must also start taking medications.

The medications are readily available and not very costly in the country. The treatment is likely to continue for life.
Doctors, however, insist that even after starting the medicine, those with hypertension should go back to their doctors for follow-up at least three to four times a year. This will help the doctors adjust dosages for optimal control of blood pressure.

“If someone does get diagnosed, they should start taking medication as per their doctor’s advice. This is essential for preventing further damage. They also need regular follow-ups to keep a check on their condition” said Dr Yadav. Both Dr Mohan and Dr Yadav said that between the follow-ups, people can self-monitor their blood pressure levels with the readily available electronic BP machines.

Dr Mohan said cutting down on salt is one of the easiest interventions that can have a good impact. The WHO recommends consuming only 2 grams of salt in a day; the report shows that on average Indians consume 10 grams of salt a day. The report also said that 34% of adults are physically inactive in the country, 4% are obese, and 28% smoke or chew tobacco.

How has the India Hypertension Control Initiative helped?

India Hypertension Control Initiative (IHCI) focuses on controlling hypertension by screening people, ensuring protocol-based treatment, and providing medicines. Through programme such as IHCI and the government’s push towards non-communicable disease screening and treatment at the primary healthcare level, India aims to put 75 million patients with hypertension or diabetes on standard care by 2025.

The IHCI has already managed to enrol 5.8 million people with hypertension from 27 states. The report flagged issues with procuring the blood pressure medicine that the programme initially faced. This led to people not returning to the centres for treatment.

The situation, however, improved by 2020. “By 2020, the IHCI had ensured that more than 70 per cent of health care facilities had ensured one month’s stock of the protocol medicines, and fewer than 10 per cent had experienced stock-outs,” the report said.